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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desijn including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> ,� <br /> ��� 2. I will be installin�the followin�: <br /> A. Tanks: f Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) naG jal. 2) �al 3) �al <br /> B. Pump Station (if required) <br /> Pump make& model (attach pump curve& <br /> literature); system desijn requires gpm at feet of head. <br /> Hijh water alarm make & model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borro�ved from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accord�nc€��vith ordinances of the City and the rejulations of the State <br /> of Nlinnesota,and cesG� at al statements tnade this application are complete,true and correct. <br /> �� � � � � <br /> SignatureofApplican � �L'K- Date: 7 G <br /> MPCA License No. ��� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staf�'I�..evie�v: Approval Denial <br /> . ` �,� ��� � � � � � � <br /> Reviewer: ��te' <br /> Reaso� for �eniaY: <br />